VSED Should Not Be a Pathway to MAiD (Though Both Are Ethically Permissible)

Recent changes in aid in dying laws have led some to argue for a pathway from Voluntarily Stopping Eating and Drinking (VSED) to Medical Aid in Dying (MAiD). Proponents point to the Sontag case as demonstrating the efficacy of the practice. This article first provides an overview of the development of the practice of VSED and MAiD and provides the ethical arguments which support both. It then moves to discussing and critiquing Pope and Brodoff's defense of VSED-as-pathway. Pope and Brodoff argue it is maleficent and inconsistent to exclude patients diagnosed with dementia from accessing aid in dying. The main crux of their argument relies on the notion of "terminal self election." In this article terminal self election is critiqued, and alternate proposals are put forward to allow incapacitated patients with dementia access to aid in dying without first having to access VSED.